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April 15, 2009

FloSeal UsedTO Stop Bleeding Could Confuse Mammograms

by Sam Savage

Dr. Kathleen Ward noticed something odd when she examined the mammogram of a patient who had recently undergone breast cancer surgery.

The Loyola University Health System radiologist saw a suspicious pattern of white specks, much like grains of salt. The specks were calcium deposits similar to microcalcifications that sometimes are a sign of early breast cancer. But it was too early for the patient's breast cancer to have returned because it had been only a month since her lumpectomy.

It turns out the microcalcifications were not from cancer. Rather, they were due to a gel that is sometimes used during surgery to stop bleeding. In a recent article in the American Journal of Roentgenology, Ward and colleagues reported seven cases in which the sealant mimicked malignant microcalcifications in mammograms.

The sealant, FloSeal, "is not recommenderd for use on breast tissue," Ward and colleagues wrote. Ward is Medical Director of Women's Health Imaging and an assistant professor in the Department of Radiology at Loyola University Chicago Stritch School of Medicine.

FloSeal, is among the products surgeons use to stop bleeding when sutures or staples are not sufficient or are impractical. FloSeal generally stops bleeding in two minutes or less. "We hope our study will raise awareness for others who may be using this product or any similar product," said first author Dr. Amy Henkel, a third-year radiology resident at Loyola.

Previous studies have described the use of FloSeal in urological surgery, such as kidney resection, and cardiovascular surgery. FloSeal does not cause imaging problems for those procedures, but should not be used in breast surgery, said study co-author Dr. Richard Cooper, a professor in the Department of Radiology at Stritch.

The study is published in the November, 2008, issue of the American Journal of Roentgenology. In six patients, the microcalcifications caused by FloSeal were seen on six-month follow-up mammograms. In the seventh patient, these microcalcifications were seen on a mammogram taken one month after lumpectomy to look for residual malignant calcifications.

Other authors include Dr. Davide Bova, an associate professor in the Stritch Department of Radiology and Dr. Katharine Yao, a former Loyola breast surgeon now at NorthShore University HealthSystem.